From the Guidelines
Glipizide should be prescribed in its extended-release (ER) formulation for most patients due to its advantages in improving medication adherence and providing more stable blood glucose control. The choice between immediate-release (IR) and extended-release (ER) formulations of glipizide depends on individual patient factors, as noted in the standards of care for diabetes management 1. For most patients, the extended-release formulation is preferred because it offers several advantages, including once-daily dosing, which improves medication adherence compared to the immediate-release version that typically requires twice-daily dosing. The extended-release formulation provides more stable blood glucose control throughout the day with fewer peaks and troughs in drug levels, potentially reducing the risk of hypoglycemia, as seen with other sulfonylureas 1. Glipizide ER is typically started at 5mg once daily with breakfast and can be titrated up to a maximum of 20mg daily based on blood glucose response. However, some patients may benefit from the immediate-release formulation if they need more flexible dosing or have difficulty swallowing the non-crushable ER tablets. Patients should take glipizide ER with breakfast to maximize its effectiveness, and blood glucose monitoring is essential when starting or adjusting the dose to ensure optimal glycemic control. Key considerations in the management of diabetes with glipizide, including its formulation, are based on the most recent guidelines that emphasize patient-centered care, considering factors such as comorbidities, hypoglycemia risk, impact on weight, cost, and patient preferences 1. Given the latest evidence, the extended-release formulation of glipizide is generally recommended for its benefits in glycemic control and patient adherence.
From the FDA Drug Label
In studies assessing the effect of colesevelam on the pharmacokinetics of glipizide ER in healthy volunteers, reductions in glipizide AUC 0–∞and C maxof 12% and 13%, respectively were observed when colesevelam was coadministered with glipizide ER When glipizide ER was administered 4 hours prior to colesevelam, there was no significant change in glipizide AUC 0–∞or C max,-4% and 0%, respectively. Therefore, glipizide should be administered at least 4 hours prior to colesevelam to ensure that colesevelam does not reduce the absorption of glipizide
Yes, glipizide can be administered as an extended-release (ER) formulation. According to the studies 2 and 2, glipizide ER can be used, but its administration should be timed carefully in relation to other medications, such as colesevelam, to avoid reduced absorption.
From the Research
Glipizide Formulation
- Glipizide is available in an extended-release (ER) formulation, which provides more stable plasma drug concentrations than the immediate-release formulation 3.
- The ER formulation may optimize patient compliance due to its once-daily regimen 3.
Efficacy of ER Formulation
- The ER formulation of glipizide is at least as effective as the immediate-release formulation in providing glycaemic control 3, 4.
- The ER formulation may have a greater effect on fasting plasma glucose levels 3, 4.
- A systematic review and meta-analysis found that sustained-release glipizide appeared to achieve similar glucose control with decreased insulin secretion, fewer hypoglycemic episodes, and higher patient compliance than immediate-release glipizide 5.
Pharmacoeconomic Implications
- The ER formulation of glipizide may have pharmacoeconomic advantages over other antidiabetic agents, including lower costs and improved patient compliance 3.
- A cost-of-treatment model found that glipizide GITS was the least costly strategy for first-line therapy in patients with type 2 diabetes mellitus 3.
Development and Validation
- A level A in vitro-in vivo correlation (IVIVC) was established for the ER formulation of glipizide, which can be used to predict the in vivo performance of the formulation 6.
- The IVIVC model was found to be predictive of the in vivo absorption of glipizide from the ER formulation 6.